Adjustment Disorder

What is adjustment disorder?

Adjustment disorder is a behavioural or emotional response to a sudden or stressful event in someone’s life. These responses are deemed to be unnatural or excessive, occur within three months of the stressor, and rarely last longer than six months after the stressor ^[1].

Stressors can include events such as:

• The death of a loved one
• Moving house
• Starting a new school or job
• Relationship issues

These stressors do not have to be sudden or unexpected: they can be natural occurrences in a person’s life.

Depending on the type of adjustment disorder someone has, their symptoms may include:

• Anxiety
• Difficulty concentrating
• Loss of appetite
• In some more extreme cases, self-harm and suicidal thoughts ^[2].

Treatment for adjustment disorder is similar to other generalized anxiety disorder or major depressive disorder.

Studies have reported the disorder has a prevalence of between 3% and 5% in primary care settings, but is often undiagnosed by general practitioners ^[2].

Types of Adjustment Disorder

The subtypes of adjustment disorder vary with symptoms experienced and their severity. Many have overlapping symptoms with each other and can all be triggered by similar stressors. ^[1]

Adjustment Disorder with anxiety:

If you are diagnosed with adjustment disorder with anxiety, you might experience nervousness, excessive worrying, and separation anxiety with trusted people - such as a family member or close friend. This form of Adjustment Disorder is especially common amongst children and young people who have experienced a loss of a loved one.

Adjustment Disorder with depressed mood:

People with adjustment disorder with depressed mood may lack interest in their usual hobbies, experience low moods, and feelings of hopelessness.

Adjustment Disorder with mixed anxiety and depression:

This type is a combination of the two types above, meaning a person could experience both depressive and anxiety symptoms at the same time.

Adjustment Disorder with disturbance of conduct:

A person who experiences this form of adjustment disorder may try to bring harm to others. Other symptoms could include violating general societal norms, such as being truant from work or school; destroying property; or becoming argumentative.

Adjustment Disorder with mixed disturbance of emotions and conduct:

Someone who experiences this form of adjustment disorder may encounter anxiety, depression, and disturbance of conduct symptoms simultaneously.

Unspecified Adjustment Disorder:

These include symptoms that do not fit into the described above groups. These are often linked with withdrawal from society and distancing oneself from loved ones.

Adjustment Disorder Symptoms

The severity and types of symptoms of adjustment disorder can be linked to the type of stressor that a person experiences and the duration of the stressor. Acute adjustment disorder occurs within 3 months of the stressor and lasts no longer than 6 months after the stressor has ended. Chronic adjustment disorder lasts longer than 6 months and is usually caused by ongoing stressors such as unemployment ^[3].

Symptoms experienced depend on the type of adjustment disorder a person’s experiences and can be physical or psychological ^[3]:

• Physical symptoms include self-harm, lack of appetite, heart palpitations, increased tiredness, and destructive behavior. Physical or behavioral symptoms are experienced across all types of adjustment disorder and are not necessarily only a consequence of specific stressors.
• Psychological symptoms include depressive symptoms or low mood, nervousness, separation anxiety, withdrawal from society, feelings of hopelessness, and lack of ambition to do activities you would usually enjoy. Again, psychological symptoms are experienced across all types of adjustment disorder and are not concretely linked to any certain stressor.

Some symptoms may be more common depending on the type of stressor. For example, a child that has recently experienced a loss of a parent may be more susceptible to separation anxiety from the other parent or close family members.

Adjustment Disorder Diagnosis

Diagnosis for suspected adjustment disorder should come from a doctor or psychiatrist. Whilst it is a psychological condition, physical tests may be conducted in order to rule out any other causes for the symptoms you are experiencing.

Diagnosis is based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These diagnostic criteria are:

• A change in emotional and/or physical behavior within 3 months of the stressor occurring
• Showing an abnormal response to the stressor that would not usually be expected (for example symptoms that go beyond what one would usually expect of a grieving person)
• These symptoms causing significant enough disruption to your daily life
• Symptoms are not related to another mental health disorder or caused by a previous diagnosis

What causes adjustment disorder?

Adjustment disorder is caused by a stressor, which is a serious event or circumstance that you may or may not normally expect. ^[4] A stressor does not necessarily have to be something objectively stressful: what matters is that the person perceives it to be stressful.

The causes of adjustment disorder differ slightly amongst age groups. Children and young adults are thought to be more susceptible to adjustment disorder since they may not have many effective coping mechanisms ^[1].

Most common stressors in adulthood ^[9] include:

• Marital troubles
• Financial troubles
• Unemployment
• Health issues with oneself or with a dependent partner or child

Most common stressors in childhood and adolescence ^[5] include:

• Family issues (e.g. divorce, trauma)
• Changing schools or problems within school
• Death of a parent or close relative
• Sexuality issues

Preventing Adjustment Disorder

As adjustment disorders are usually caused by unexpected and rare stressors, there are no guaranteed ways to prevent it. However, if an identifiable stressor is known to be coming up in your own or your child’s life then there are some ways to prepare. These include ^{[6] [7]}:

• Ensuring that you and your family have a solid support network in place to rely on
• Keeping with a routine during and after the stressor occurs
• Living healthily, including a balanced diet and regular exercise
• Speaking to a mental health professional about healthy ways to manage stress

Acute disorders tend to resolve 6 months after the stressor occurs, so ensuring that the stressor is not ongoing is a key step to preventing chronic adjustment disorders from developing.

Adjustment Disorder Treatment

Treatment for adjustment disorders can vary on a person by person basis. Most minor cases can be resolved through different forms of therapy whilst medication is usually reserved for the more severe cases at your doctor’s discretion ^[1].

Therapy

Therapy can be a viable route to take for patients of adjustment disorder as it can help you better control your emotions, and help you understand what is happening and why, all whilst in the presence of a professional therapist who can help guide you and provide emotional support.

Individual Cognitive Behavioral Therapy

This form of treatment is used to improve stress management skills as well as problem-solving and communication abilities. It focuses on changing the negative beliefs someone has regarding themselves or, in this case, a certain situation/event.

Family Therapy

Family therapy can be used as an effective therapy method especially when the stressor affects the whole family (loss of a parent, financial uncertainty etc.). This involves improving communication skills and strengthening relationships within your family.

Peer Therapy

Peer therapy can be especially effective with adolescents suffering from adjustment disorders, allowing them to build the tools needed to establish peer support networks.

Medication

Adjustment disorder medications have been shown to have limited value in treating adjustment disorders ^[1]. The medications often prescribed are similar to other medications given to people suffering from related mental disorders such as depression and anxiety.

Due to the short term nature of adjustment disorders, medication is only prescribed in certain cases. You should consult your doctor and explore other alternatives first.

Self-care for Adjustment Disorder

Adjustment disorders can be managed with self-care methods. These are similar to the preventative measures that you can take and include using friend and family support networks, maintaining a routine either for yourself or your child, trying to keep a balanced diet, and doing regular exercise.

However, it is always best to seek medical help alongside self-care methods. Some symptoms such as depressive moods and anxiety can develop into more serious mental health problems, including depression or drug and alcohol use disorders, if left untreated.